Acute lymphoblastic leukemia: a comprehensive review and 2017 update.

Acute lymphoblastic leukemia: a comprehensive review and 2017 update.
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急性淋巴细胞白血病:全面回顾和 2017 年更新。

DOI:
10.1038/bcj.2017.53
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发表时间:
2017-06-30
影响因子:
12.8
通讯作者:
Abdul-Hay M
Abdul-Hay M
中科院分区:
医学1区
文献类型:
--
作者:
Terwilliger T;Abdul-Hay M

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急性淋巴细胞性白血病(ALL)是成人第二常见的急性白血病,仅在美国每年的发病率就超过6500例。ALL的特点是涉及淋巴前体细胞分化和增殖的染色体异常和遗传改变。在成人中,75%的病例来自B细胞谱系的前体,其余的病例由恶性T细胞前体组成。传统上,风险分层基于临床因素,如年龄、白细胞计数和对化疗的反应;然而,识别反复发生的基因改变有助于改善个体预后并指导治疗。尽管在治疗方面取得了进展,但治疗的核心仍然是对符合条件的候选人使用长春新碱、皮质类固醇和蒽环类药物并进行异基因干细胞移植的多药联合化疗。老年患者往往无法耐受这样的方案,预后特别差。在这里,我们回顾了ALL治疗的主要近期进展。
Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults, with an incidence of over 6500 cases per year in the United States alone. The hallmark of ALL is chromosomal abnormalities and genetic alterations involved in differentiation and proliferation of lymphoid precursor cells. In adults, 75% of cases develop from precursors of the B-cell lineage, with the remainder of cases consisting of malignant T-cell precursors. Traditionally, risk stratification has been based on clinical factors such age, white blood cell count and response to chemotherapy; however, the identification of recurrent genetic alterations has helped refine individual prognosis and guide management. Despite advances in management, the backbone of therapy remains multi-agent chemotherapy with vincristine, corticosteroids and an anthracycline with allogeneic stem cell transplantation for eligible candidates. Elderly patients are often unable to tolerate such regimens and carry a particularly poor prognosis. Here, we review the major recent advances in the treatment of ALL.
在复发/难治性急性淋巴细胞性白血病中,有或没有超vad的5-aza-2'-脱氧胞苷(去替替啶)的安全性和临床活性。
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